100% satisfaction guarantee Immediately available after payment Both online and in PDF No strings attached
logo-home
Previously searched by you
Previously searched by you
logo
Surgery MCQs Arterial,Venous Disorders & Lymphatic Disorders Review Questions with Explanations of Answers | latest upate 2024 £6.54
Add to cart
Quickly navigate to
Preview
  2.  
  3. Studies
  4.  
  5. Studies
  6.  
  7. Studies

Exam (elaborations)

Surgery MCQs Arterial,Venous Disorders & Lymphatic Disorders Review Questions with Explanations of Answers | latest upate 2024
 0 purchase

Surgery MCQs Arterial,Venous Disorders & Lymphatic Disorders Review Questions with Explanations of Answers | latest upate 2024

Preview 4 out of 50  pages

Document information

  • June 21, 2024
  • 50
  • 2023/2024
  • Exam (elaborations)
  • Questions & answers

Subjects

  • surgerymcqsarterialvenousdisorderslymphatic
  • surgery mcqs arterialvenous disorders lymphatic

Written for

All documents for this subject (806)

Seller

avatar-seller
ACTUALSTUDY

Reviews received

Content preview

Review of Critical Care Medicine




Surgery MCQs (Arterial,Venous Disorders &
Lymphatic Disorders)

Posted by Dr KAMAL DEEP on May 31, 2011

Commonest cause of A-V fistulae is – (AI 88)
a) Congenital b) Traumatic
c) Surgical creation d) Tumour erosion

Congenital A-V fistulas in the thigh will be associated with all except – (PGI 89)
a)Increased cardiac output
b)Increased skin tempreture
c)Gigantism of limb
d)Superficial venous engorgement

Continuous murmur is not found in- (AIIMS 89)
a)PDA
b)Systemic A-V fistula
c)Rupture of sinus of valsalva
d)Double outlet right ventricle

AV fistula leads to all except – (AIIMS 98)
a)Sinus tachycardia
b)Increased preload
c)Cardiac arrythm ias
d)Increased cardiac output

AV fistula causes – (PGI 98)
a) dec Diastolic b) inc Venous return
c) dec Venous congestion d) inc Systolic fillin

Nicoladoni branham sign is – (PG198)
a)Compression cause bradycardia
b)Compression cause tachycardia

,c)Hypotension
d)Systolic filling

True regarding AV fistula is – (PGI 02)
a)Leads to cardiac failure
b)Causes local gigantism
c)Can cause ulcers
d)Cause excess bleeding on injury
e)Closes spontaneously

Complications arising out of A – V fistula done for renal failure include the following
EXCEPT –
a)Infection (Jipmer 03)
b)Thrombosis
c)High output cardiac failure
d)Necrosis of the distal part

Ans. is ‘d’ i.e., Necrosis of the distal part [Ref Sabiston 161"/e p.1456; Love & Bailey 246/e p.950 ;
23"//e p.23]

Pulsating varicose vein in a young adult is due to-
a)Arteriovenous fistula (AIIMS 92)
b)Sapheno femoral incompetence
c)Deep vein thrombosis
d)Abdominal tumour

In Osler Weber Rendu syndrome A.V. fistulas occur.

The clinical features depend on the location and size of the fistula. Frequently, a pulsatile
mass is palpable, and a thrill and bruit lasting throughout systole and diastole are present
over the fistula. With longstanding fistulas, clinical manifestations of chronic venous
insufficiency, including peripheral edema; large, tortuous varicose veins; and stasis
pigmentation become apparent because of the high venous pressure. Evidence of ischemia
may occur in the distal portion of the extremity. Skin temperature is higher over the
arteriovenous fistula. Large arteriovenous fistulas may result in an increased cardiac output
with consequent cardiomegaly and high-output heart failure.

The diagnosis is often evident from the physical examination. Compression of a large
arteriovenous fistula may cause reflex slowing of the heart rate ( Nicoladoni -Branham sign).

Physiological effect
The combination of an uncontrolled leak from the high-pressure arterial system and an
enhanced venous return and venous pressure results in an increase in pulse rate and cardiac
output. The pulse pressure is high if there is a large and persistent shunt. Left ventricular
enlargement and, later, cardiac failure occur. A congenital fistula in the young may cause
overgrowth of a limb. In the leg, indolent ulcers may result from relative ischaemia below the
short circuit.
Clinical signs

,Clinically, a pulsatile swelling may be present if the lesion is relatively superficial. On
palpation, a thrill is detected and auscultation reveals a buzzing continuous bruit. Dilated
veins may be seen, in which there is a rapid blood flow. Pressure on the artery proximal to the
fistula causes the swelling to diminish in size, the thrill and bruit to cease, the pulse rate to
fall [known variously as Nicoladoni’s (1875) or Branham’s (1890) sign] and the pulse pressure
to return to normal.




AV (arteriovenous) fistulas are recognized as the preferred access method. To create a fistula,
a vascular surgeon joins an artery and a vein together through anastomosis. Since this
bypasses the capillaries, blood flows rapidly through the fistula. One can feel this by placing
one’s finger over a mature fistula. This is called feeling for "thrill" and produces a distinct
‘buzzing’ feeling over the fistula. One can also listen through a stethoscope for the sound of
the blood "whooshing" through the fistula, a sound called bruit.

Fistulas are usually created in the nondominant arm and may be situated on the hand (the
‘snuffbox‘ fistula’), the forearm (usually a radiocephalic fistula, or so-called Brescia-Cimino
fistula, in which the radial artery is anastomosed to the cephalic vein), or the elbow (usually a
brachiocephalic fistula, where the brachial artery is anastomosed to the cephalic vein). A
fistula will take a number of weeks to mature, on average perhaps 4–6 weeks. During
treatment, two needles are inserted into the fistula, one to draw blood and one to return it.

, The advantages of the AV fistula use are lower infection rates, because no foreign material is
involved in their formation, higher blood flow rates (which translates to more effective
dialysis), and a lower incidence of thrombosis. The complications are few, but if a fistula has a
very high blood flow and the vasculature that supplies the rest of the limb is poor, a steal
syndrome can occur, where blood entering the limb is drawn into the fistula and returned to
the general circulation without entering the limb’s capillaries.

Maximum tourniquet time for the upper limb is –
a) 1/2 hour b) 1 hr (JIPMER 87)
c) 1-1/2 hrs. d) 2 hrs
e) 2-1/2 hrs

Sabiston:- Tourniquet Application:- The tourniquet is used to provide a bloodless field so
that clear visualization of all structures in the operative field is obtained. Penrose drains,
rolled rubber glove fingers, or commercially available tourniquets can be used on digits.
Great care must be taken in using any constrictive device on digits because narrow bands
cause direct injury to underlying nerves and digital vessels. With the use of an arm
tourniquet, the skin beneath the cuff must be protected with several wraps of cast padding.
During skin preparation, this area must be kept dry to prevent blistering of the skin under an
inflated cuff over moist padding. The cuff selected needs to be as wide as the diameter of the
arm. Standard pressures used are 100 to 150 mm Hg greater than systolic blood pressure. The
cuff is deflated every 2 hours for 15 to 20 minutes (5 minutes of reperfusion for every 30
minutes of tourniquet time) to revascularize distal tissues and to relieve pressure on
nerves locally before reinflating the cuff for more extensive procedures. Exsanguination of
the extremities is performed by wrapping the extremity with a Martin’s bandage in all cases,
except those involving infection or tumors. In these latter cases, because of the possibility of
embolization by mechanical pressure, exsanguination by bandage wrapping needs to be
avoided. Simple elevation of the extremity for a few minutes before tourniquet inflation
suffices.

Bailey:- Tourniquet:- A bloodless field is essential for accurate surgery. A well-padded
tourniquet above the elbow, inflated to 75 mmHg pressure over the systolic blood pressure, is
usually satisfac​tory. The time should not exceed 2 hours. An Esmarch bandage or a rubber-
tube exsanguinator are effective, but should be avoided for tumour or infection cases lest the
pathology is spread systemically. In the finger, a tourniquet can be made by placing a sterile
glove on the patient, snipping off the tip and then rolling the glove down to the base of the
finger.



Thromboembolism after pelvic surgery is usually from the veins – (A189)
a) iliac b) Calf
c) Femoral d) Pelvic

An obese patient develops acute oedematous lower limb following a Pelvic surgery. Deep
vein thrombosis is suspected . The most useful investigation in this case would be – (UPSC
2002)

The benefits of buying summaries with Stuvia:

Guaranteed quality through customer reviews

Guaranteed quality through customer reviews

Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.

Quick and easy check-out

Quick and easy check-out

You can quickly pay through credit card for the summaries. There is no membership needed.

Focus on what matters

Focus on what matters

Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!

Frequently asked questions

What do I get when I buy this document?

You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.

Satisfaction guarantee: how does it work?

Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.

Who am I buying these notes from?

Stuvia is a marketplace, so you are not buying this document from us, but from seller ACTUALSTUDY. Stuvia facilitates payment to the seller.

Will I be stuck with a subscription?

No, you only buy these notes for £6.54. You're not tied to anything after your purchase.

Can Stuvia be trusted?

4.6 stars on Google & Trustpilot (+1000 reviews)

68175 documents were sold in the last 30 days

Founded in 2010, the go-to place to buy revision notes and other study material for 15 years now

Start selling
£6.54
  • (0)
Add to cart
Added